Morgan: Examining co-payments on the NHS

Speech to the National Assembly for Wales.

"I am certainly earning my salary this afternoon. In moving this motion, I am pleased that we have the opportunity to debate what is a complex matter—I think that we would all accept that—but one that deserves our fullest attention. Last Tuesday, the Secretary of State for Health announced a review of the policy relating to co-payments. I welcome that because in our view, the banning of co-payments goes against the core values of the NHS—in fact, one of its most cherished principles, namely that treatment should be free at the point of use. The Assembly Government has said that it will monitor the review by the Department of Health, so the purpose of this debate is to find out what the view of the Assembly Government and this Assembly Minister on co-payments is and where we think the direction of travel needs to be on this difficult issue. I strongly believe that the people of Wales will want to know the view of their health Minister on this, and I look forward to hearing from her in this debate.

Many people in and outside the Chamber will recognise the problem: there is a grave injustice and inconsistency in how the NHS handles patients who make some use of private care. In some cases where the NHS cannot or will not provide new and relatively expensive drugs, patients have been willing to fund them privately. Lucentis, as we heard in the earlier debate is an example of that. However, this issue has also related to key areas, such as cancer and heart disease.

The issue has come to a head in recent months as a number of cancer patients have been banned from receiving national health service care after topping up their treatment. One of the most high-profile cases was that of Linda O'Boyle, a 64-year-old from Essex who was diagnosed with bowel cancer in 2006. She received NHS treatment including chemotherapy but, after discussions with her clinician, decided that she needed an eight-week course of a drug called cetuximab. She paid £11,000 for that course of treatment, which is not available on the NHS but which had been recommended by her clinician to prolong her life. She was subsequently denied the basic package of NHS care that she had previously been receiving. Sadly, she died in March this year.

That is a high-profile case and has been cited by Members of Parliament in the House of Commons as the reason why this issue needs to be addressed. There have been, and continue to be, a whole raft of cases similar to that of Linda O'Boyle. If a patient opts for some private treatment, that should not mean that the NHS cannot treat patients equally in respect of the state-funded care that they receive. If the Government refuses to acknowledge that, it will walk away from those people in Wales who are dying, and whose only offence is to use their own money to try to extend their own life. Patients seeking co-payments are not asking for special favours, preferential treatment, or even a handout from the national health service; they are simply asking for their package of care to be continued, alongside the top-up treatment that they have decided to pay for.

Co-payments are already happening throughout the NHS and other public services. If I were to go to an optician tomorrow as ân NHS patient, I could receive a free pair of glasses but there is nothing preventing me from using my own money to buy contact lenses. NHS care is not withdrawn at that point. Likewise, if I were to go to a dentist and have a filling on the NHS and then pay privately for teeth-cleaning or whitening, the NHS care would not be withdrawn. Meanwhile, we have private beds in NHS hospitals, using NHS equipment and staff, and again, patients do not have other aspects of NHS care withdrawn. We could also look outside the NHS at other public services: state education is not withdrawn simply because a child has access to private tuition. The state education system is there for everyone, regardless of whether private tuition is accessed.

The policy in respect of co-payments right across public services is inconsistent. The current NHS guidelines say that an individual cannot simultaneously be an NHS and a privately funded patient of the same NHS hospital within the same episode of care. The problem, and hence the complexity, is around what constitutes an 'episode of care'. Many patients require treatment that could be classed as several episodes of care.

Those who believe in maintaining the ban on co-payments say that removing it will create a two-tier health system. I am afraid that, after looking at the NHS in Wales today, indeed, across the United Kingdom, one could argue that a two-tier system already exists. If you compare those who have to rely on drugs that the NHS can afford with those who are able to fund a drug recommended by their clinician that is not provided by the NHS, you see the nature of the two-tier system in healthcare demonstrated. It is the inability of the NHS to sanction and properly resource drugs and therapies that creates that two-tier system in the first place.

My concern now is that the Welsh Assembly Government might sit still and watch what happens across the border in England. I accept that reinventing the terms of the review may not be necessary, but the Minister has to look at the Welsh NHS to tease out what is peculiar to Wales that might have to be addressed if a review in England recommends lifting the ban on co-payments. We may have to do things differently in Wales. If this unjust policy is reversed in England, I believe that the Assembly Government will have to do the same. It would be inconceivable for the ban on co-payments to be reversed in England but for us to maintain it in Wales.

We are a proud nation that has supported the NHS since its inception 60 years ago. All those living in Wales, of whatever background and political creed, believe strongly in the principles of the national health service. As we approach the sixtieth anniversary of the creation of that wonderful institution, we should take this opportunity to right one of the wrongs in today's healthcare system."